John A D I E N G Adwok | University of Nairobi, Kenya (original) (raw)
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Papers by John A D I E N G Adwok
South Sudan Medical Journal, 2010
South Sudan Medical Journal, 2011
The priority of the draft five year Strategic Health Policy for the Republic of South Sudan (2011... more The priority of the draft five year Strategic Health Policy for the Republic of South Sudan (2011-2015) is to improve maternal and child health and eradicate communicable diseases. The policy is generally silent on the issue of emerging non-communicable diseases (NCDs). The population is in epidemiological transition and at risk of acquiring these diseases because of lifestyle and behavioural changes as more people move to urban areas. For example, recent research in South Sudan found 36% of the sampled population with elevated blood pressure (1). NCDs are difficult to prevent and their complications usually require hospital based care. While acknowledging the vital importance of Primary Health Care (PHC) in health promotion and disease prevention, there is need to improve existing hospital based secondary services and develop essential tertiary services in order to achieve an integrated system that allows everyone equitable access to health care
East African Medical Journal, 2016
In acute colonic pseudo-obstruction (ACPO) there is colonic distension without an organic obstacl... more In acute colonic pseudo-obstruction (ACPO) there is colonic distension without an organic obstacle (intrinsic or extrinsic to intestinal wall). This becomes a potential site of ceacal rapture which can lead to the demise of the patient. Presented is a case of a mother who had spontaneous caecal rapture five days after Caesarean delivery. At Laparotomy the ceacal rapture was confirmed and a colostomy was done. The patient succumbed in Intensive care unit two days post-operatively.
South Sudan Medical Journal, 2015
East African Medical Journal, Aug 1, 2002
The Annals of African Surgery, 2015
This essay discusses factors considered by researchers when developing a sampling plan including ... more This essay discusses factors considered by researchers when developing a sampling plan including the frame, sampling unit, sample size, target population, precision, and stratification. The sampling methods of probability, both simple and systematic were also defined and compared on their utility for sampling populations. The usefulness of sampling as applied in a quantitative survey study is illustrated by evaluating an article using the characteristics of comprehensiveness, probability of selection, and efficiency.
South Sudan Medical Journal, 2016
This article is meant for medical officers and surgeons in training who might be called upon to p... more This article is meant for medical officers and surgeons in training who might be called upon to perform this procedure in the absence of a trained general surgeon. The techniques described here are the ones used by the author for this procedure and might differ from those used by other surgeons. However, the principles of the operation are universal. This procedure is predominantly performed laparoscopically in the author's practice as is the case in most modern hospitals with the necessary equipment and expertise. The open procedure is the standard in many hospitals in developing countries and when there is a need to convert to open during difficult laparoscopic procedures.
Journal of Biology, Agriculture and Healthcare, 2013
A hospital can be held liable under the general doctrine of respondeat superior in a case when an... more A hospital can be held liable under the general doctrine of respondeat superior in a case when an employee commits malpractice. This tort liability is applicable even when the employer is without fault because the employee was acting in the scope of his or her employment when the negligent act or omission allegedly happened. Attending physicians working in hospitals are considered independent contractors rather than employees in some situations, making the theory of respondeat superior inapplicable, and the physician has to bear full liability when sued for malpractice while treating a patient in a hospital. More often than not, hospitals are implicated for negligently granting privileges to an unlicensed or incompetent physician. Hospitals in developing countries are increasingly implicated in malpractice litigation following the doctrine of respondeat superior. Due to the dramatic circumstances that surround them, surgical malpractice cases are a cause for concern to hospital adm...
South Sudan Medical Journal, 2010
South Sudan Medical Journal, 2011
The priority of the draft five year Strategic Health Policy for the Republic of South Sudan (2011... more The priority of the draft five year Strategic Health Policy for the Republic of South Sudan (2011-2015) is to improve maternal and child health and eradicate communicable diseases. The policy is generally silent on the issue of emerging non-communicable diseases (NCDs). The population is in epidemiological transition and at risk of acquiring these diseases because of lifestyle and behavioural changes as more people move to urban areas. For example, recent research in South Sudan found 36% of the sampled population with elevated blood pressure (1). NCDs are difficult to prevent and their complications usually require hospital based care. While acknowledging the vital importance of Primary Health Care (PHC) in health promotion and disease prevention, there is need to improve existing hospital based secondary services and develop essential tertiary services in order to achieve an integrated system that allows everyone equitable access to health care
East African Medical Journal, 2016
In acute colonic pseudo-obstruction (ACPO) there is colonic distension without an organic obstacl... more In acute colonic pseudo-obstruction (ACPO) there is colonic distension without an organic obstacle (intrinsic or extrinsic to intestinal wall). This becomes a potential site of ceacal rapture which can lead to the demise of the patient. Presented is a case of a mother who had spontaneous caecal rapture five days after Caesarean delivery. At Laparotomy the ceacal rapture was confirmed and a colostomy was done. The patient succumbed in Intensive care unit two days post-operatively.
South Sudan Medical Journal, 2015
East African Medical Journal, Aug 1, 2002
The Annals of African Surgery, 2015
This essay discusses factors considered by researchers when developing a sampling plan including ... more This essay discusses factors considered by researchers when developing a sampling plan including the frame, sampling unit, sample size, target population, precision, and stratification. The sampling methods of probability, both simple and systematic were also defined and compared on their utility for sampling populations. The usefulness of sampling as applied in a quantitative survey study is illustrated by evaluating an article using the characteristics of comprehensiveness, probability of selection, and efficiency.
South Sudan Medical Journal, 2016
This article is meant for medical officers and surgeons in training who might be called upon to p... more This article is meant for medical officers and surgeons in training who might be called upon to perform this procedure in the absence of a trained general surgeon. The techniques described here are the ones used by the author for this procedure and might differ from those used by other surgeons. However, the principles of the operation are universal. This procedure is predominantly performed laparoscopically in the author's practice as is the case in most modern hospitals with the necessary equipment and expertise. The open procedure is the standard in many hospitals in developing countries and when there is a need to convert to open during difficult laparoscopic procedures.
Journal of Biology, Agriculture and Healthcare, 2013
A hospital can be held liable under the general doctrine of respondeat superior in a case when an... more A hospital can be held liable under the general doctrine of respondeat superior in a case when an employee commits malpractice. This tort liability is applicable even when the employer is without fault because the employee was acting in the scope of his or her employment when the negligent act or omission allegedly happened. Attending physicians working in hospitals are considered independent contractors rather than employees in some situations, making the theory of respondeat superior inapplicable, and the physician has to bear full liability when sued for malpractice while treating a patient in a hospital. More often than not, hospitals are implicated for negligently granting privileges to an unlicensed or incompetent physician. Hospitals in developing countries are increasingly implicated in malpractice litigation following the doctrine of respondeat superior. Due to the dramatic circumstances that surround them, surgical malpractice cases are a cause for concern to hospital adm...
A Dissertation Presented in Partial Fulfillment Of the Requirements for the Degree Doctor of Philosophy, School of Public Service Leadership, Capella University., 2010
The research problem addressed a gap in the knowledge base regarding the predictive relations amo... more The research problem addressed a gap in the knowledge base regarding the predictive relations among the pattern, choice, and volume of alcohol consumption and blood pressure. A systematic probability sampling single-stage procedure was conducted to recruit participants (N = 421) from the civil servants of the government of Southern Sudan in the town of Juba, Sudan. The mean age of the participants was 44.5 ± 10.9 years with a median of 45, mode of 46, and a variance of 118.3. Seventy-seven percent were males and 23% females. Thirty-six percent of the participants (N = 421) had raised or elevated systolic blood pressures. The study variables dichotomized in the participants (n = 163) who consumed alcohol were as follows: The pattern of alcohol consumed from frequent/daily drinkers to infrequent drinkers, choice of alcohol from liquor to non-liquor, and the volume from heavy drinkers (≥ 3 drinks per day) to moderate/light drinkers (≤ 2 drinks per day). A stepwise multiple regression analysis was conducted to examine the extent to which pattern, choice, and volume of alcohol consumed predicted blood pressure. Age, gender, and body mass index were included in the regression equation as intervening variables. Age statistically predicted blood pressure levels, R² = .161, F(1,161) = 30.878, and p < .001. The pattern of alcohol consumed added to this prediction, R² = .183, ΔR² = .022, F(2,160) = 17.953, and p < .001. Age alone accounted for 16.1% of the change in the levels of systolic blood pressure whereas both variables accounted for 18.3% of the change. The prediction equation indicated participants who consumed alcohol frequently or daily had systolic blood pressures of 8.537 mmHg higher than those who drank infrequently. Similarly, daily alcohol consumption and age could have had a cumulative negative effect as blood pressure goes up by .782 mmHg for every year of life after the age of 25 years. Age and the pattern of alcohol consumed significantly (p < .001) predicted blood pressure levels, indicating frequent or daily drinkers have a higher risk of hypertension than less frequent drinkers do. Further population-based research is recommended to validate the current research findings.
South Sudan, the newest country in the world, is today a very pertinent example of a ‘limited res... more South Sudan, the newest country in the world, is today a very pertinent example of a ‘limited resource’ state faced by overwhelming and unprecedented complex emergencies, due to the ongoing civil strife. Effectively regulating healthcare services and professionals in an unstable and insecure environment has been a daunting task for the South Sudan General Medical Council (SSGMC), the body established three years ago to regulate medical, dental and pharmacy practice as well as healthcare institutions in the country.
Private hospitals, clinics, and traditional healing centers rapidly mushroomed all over the country soon after independence in 2011. The quality, nature and cost of health care services was left to local health authorities at the time until the SSGMC was established three years ago. Since then, traditional regulatory methods such as licensing and certification through the regulatory strategy of command and control have had little impact on controlling the behaviour in the healthcare sector. There is empirical evidence that this is a result of the limited resources available to government and because of the powerful countervailing incentives that encourage deviant behaviour to continue.
The purpose of this presentation is to give an overview of the current regulatory environment in South Sudan and highlight the seemingly insurmountable obstacles faced by the SSGMC to establish itself as a regulatory body that will ensure access to safe health care by all. We also propose further research to identify hybrid regulatory methods that could be more effective and efficient in regions where the rule of law is difficult to enforce.
A hospital can be held liable under the general doctrine of ‘Respondeat Superior’ even when it is... more A hospital can be held liable under the general doctrine of ‘Respondeat Superior’ even when it is without fault in a case when an employee commits malpractice. The employee must have been acting in the scope of his or her employment when the negligent act or omission occurred.
Attending and visiting doctors working in hospitals are considered independent contractors rather than employees and have to bear full liability when sued for malpractice while treating a patient. The hospital is more often than not enjoined when such cases arise for ‘negligently granting privileges to an unlicensed or incompetent doctor.’
Countries with ‘limited resources’ and experiencing social upheaval like South Sudan invariably h... more Countries with ‘limited resources’ and experiencing social upheaval like South Sudan invariably have enhanced health care regulatory needs due to a break down in law and order.
Controlling the number and distribution of health care facilities and quality of care as well as protecting consumers from opportunistic behavior or malpractice demands special regulatory capacities
Secondary care is the provision of a specialized medical service by a specialist or a hospital ... more Secondary care is the provision of a specialized medical service by a specialist or a hospital on referral by a primary care doctor or health care worker. Tertiary care is the level of care that consists of complex procedures given in a health institution that has highly trained specialists and often advanced technology.
Talk presented at the "Current Trends in Thyroid Surgery" Workshop conducted at the Moi Teaching ... more Talk presented at the "Current Trends in Thyroid Surgery" Workshop conducted at the Moi Teaching and Referral Hospital on 15-16 November, 2018 in Eldoret, Kenya. The talk was followed by live surgical sessions of thyroid procedures to demonstrate the techniques described in the talk.
Talk given during the "Current Trends in Thyroid surgery workshop" facilitated by the author at t... more Talk given during the "Current Trends in Thyroid surgery workshop" facilitated by the author at the Moi Teaching and Referral Hospital in Eldoret Kenya 15-16 November, 2018. The talk was followed by practical live surgical sessions in the Operating Theatres (Rooms).
Keynote address on patient safety at the 7th Annual Nursing Scientific Symposium at the Nairobi ... more Keynote address on patient safety at the 7th Annual Nursing Scientific Symposium at the Nairobi Hospital on 4th November, 2017
Breast conservation surgery remains the gold standard in the treatment of early breast cancer. Ho... more Breast conservation surgery remains the gold standard in the treatment of early breast cancer. However, new innovative techniques including nipple preserving mastectomy, percutaneous ablation and transcutaneous ablations of small tumors are rapidly being introduced. Although many of these procedures still face validation problems especially the transcutaneous techniques, there is no doubt that the new paradigm of less and more effective treatments is the new frontier in the surgical treatment of breast cancer.
The technological advances of medicine in recent decades have made it possible to extend the life... more The technological advances of medicine in recent decades have made
it possible to extend the life of critically ill patients even in resource
poor countries in Sub-Saharan Africa. Modern biomedical technology
restores some patients to health but also allows others to live in a
severely disabled stage and prolongs the dying process for others. The
increasing role of technology in prolonging life in severely debilitated
patients, with no possibility of restoring health, is on a collision course
with moral norms in many societies. Patients have a limited say on
when to initiate these complex treatments and when to stop them
in the absence of advance directives or living wills......
